Maryland health officials have confirmed two more cases of Zika among people who traveled to countries experiencing outbreaks of the mosquito-borne virus, bringing the total confirmed cases in the state to three.

Those infected have not been identified and it's not known whether any were pregnant, which would put their fetuses at particular risk. Scientist are increasingly convinced of a link between the mosquito-borne virus and a devastating birth defect called microcephaly that results in babies born with unusually small heads and brain damage.


As a result, a handful of pregnant women in the United States who've been exposed to the virus either miscarried or had abortions after ultrasounds revealed severe birth defects in their unborn children.

On Friday, the U.S. Centers for Disease Control and Prevention reported that Zika infections have been confirmed in nine pregnant U.S. women. The women contracted the virus while traveling in American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico or Samoa.

A total of 147 cases of Zika in the United States and its territories have been reported to the CDC, with most cases related to travel to a country experiencing an outbreak. Latin American and Caribbean countries have been affected the most, and the CDC has issued travel warnings to about 30 countries and told pregnant women to consider postponing trips to areas with active transmission of Zika.

There have been no direct transmissions of the virus from a mosquito in the United States, but there have been two confirmed and four suspected cases of sexual transmission because the women's only risk factor was sexual contact with a man who had recently traveled to an affected country and had symptoms such as a fever, rash, pink eye or joint pain.

Among the pregnant women with the virus, the CDC reported two miscarried and two had abortions after ultrasounds showed severe birth defects. The CDC also said two gave birth to healthy babies, two continue their pregnancies without known complications and one gave birth to a baby with a brain defect.

A health official said that baby was born to a woman in Hawaii who had lived in Brazil early in her pregnancy when officials believe the impacts from Zika may be the greatest. Other cases were reported in Illinois and Florida.

There have been no hospitalizations or deaths among the pregnant women, according to the CDC, which also is investigating 10 additional reports of pregnant travelers with Zika

"Even though the [U.S.] numbers are small, they are of considerable interest," said CDC Director Dr. Tom Frieden during a news conference Friday. "We understand that the occurrence of fetal malformation, fetal loss or miscarriage, or a child with a birth defect is something that can be devastating to a family."

Still, the proportion of U.S. pregnancies that appear to have been harmed due to the mosquito-borne infection "is greater than we would have expected," Dr. Denise Jamieson, co-lead of the Pregnancy and Birth Defects Team with the CDC Zika Virus Response Team, said during the news conference.

Separately Friday, the U.S. Food and Drug Administration authorized a new diagnostic test for the Zika virus on an emergency basis, the CDC announced. The test, which detects antibodies the body makes to fight a Zika virus infection, will be distributed to qualified domestic and international laboratories starting in the next two weeks.

The antibodies appear in an infected person's blood four to five days after that person becomes ill. The test is intended for use on blood samples from people with a history of symptoms associated with Zika and people who have recently traveled to an area where the virus is active.

Most people are not sickened by Zika, and it only caught authorities' attention when the number of babies born with microcephaly began climbing in Brazil. There have been more than 5,600 cases of the defect suspected or confirmed in Brazil since last spring when the epidemic began, according to the World Health Organization.

Doctors have been instructed by the CDC and other health agencies to tell women who are pregnant and have been to a country with active transmission of Zika to call their health care provider. They can monitor for complications through blood tests and ultrasounds, though there is no cure or specific treatment for Zika.

In some cases, women in affected countries have been told to consider putting off pregnancy. And Pope Francis suggested last week that contraceptives might be used to prevent the spread of Zika despite the Catholic Church's ban on most forms of birth control.


The World Health Organization declared Zika a public health emergency and efforts are underway to develop a vaccine. In the meantime, women in the affected countries and visitors are urged to cover up and use mosquito repellent.

The Maryland Department of Health and Mental Hygiene is now testing possible cases of Zika in the state lab, but on Friday, Christopher Garrett, a spokesman for the department, couldn't say if there were more than the 17 potential cases reported earlier this month.

Late Friday, the CDC issued travel advice for those considering going to the 2016 Summer Olympic Games in Rio de Janeiro. It advised women who are pregnant to consider not going. If a pregnant woman must go, the CDC recommended steps to prevent mosquito bites during your trip. To reduce the risk of transmission from a male partner who goes to the Olympics, CDC said to use condoms or abstain from sex during the pregnancy.

For women who are trying to become pregnant, which likely includes some athletes, the CDC recommended learning about the risk of infection and strictly following steps to prevent mosquito bites.

The Associated Press and Tribune Newspapers contributed to this article.